Unwell by Mike McRae

Unwell: What Makes a Disease a Disease?

Reviewed by Norrie Sanders

Unwell covers a lot of ground. In Mike McCrae’s mind, a book on disease can deal with topics as diverse as circumcision, euthanasia, addiction, obesity, embalming, biohacking and elite sport. He challenges our concept of disease by demonstrating how changes in fashion and culture can invent or obliterate medical diagnoses.

A more conventional book might have focussed on specific diseases and elaborated their history and current state of knowledge. Unwell instead offers a wholly different structure and content. The six parts have succinct titles – “Broken”, “Infected”, “Insane”, “Abnormal” and even “Dead” and “Well”.  Mental and physical health are entwined in this structure. Some of the sub-parts have unexpected foci: “Dirty”, “Weak”, “Guilty” , “Bad” and “Extraordinary” are not titles normally found in medical compendia.

These headings are an unreliable signpost to an eclectic collection of history, statistics and anecdotes.   From the outset, Mike makes it clear that it is a fiendishly difficult task to classify all diseases, syndromes, illnesses and weaknesses.

With a sense of relief, some of the historic diseases have been dumped from the medical lexicon. Why do citizens of the United States no longer suffer from the common affliction of Americanitis? Is homesickness, or more accurately, Nostalgia, still an inflammatory disease with potentially fatal consequences? When did women cease to suffer from Hysteria – a diagnosable disease characterised by a uterus wandering through the abdominal cavity?

Replete with distilled knowledge, but written in a very approachable style, every page is dense with information:  the familiar, the surprising and the downright weird. The book is full of little factual gems that are insightful and well expressed: “The top ten highest grossing drugs in the United States help as few as one in twenty five who take them. The statins we take to control cholesterol levels might be relatively useless for 98% of people who use them.”

Mike loves to introduce new chapters with apparent non-sequiturs. Many of these are humorous and many are from his personal life. Sometimes they can feel a little contrived but they provide an entertaining way to change the focus: “Entering our chubby little bundles of gurgling puke and pride into baby photo competitions is a rite of passage for many expanding families across the modern world “ is the lead for a fascinating section on better babies, fitter families and eugenics (yes, really).

There is a distinct Australian tone and some of the humour invokes scatology:

“I home-brew. It might be a bit of a cliché, but there really is nothing quite as magical as throwing a packet of dried microbes into diluted mash and waiting for a delicious stout to bubble forth…brewing connects my love of microbiology with an ancient tradition. You might like to breed rabbits or fish, but at least I get to enjoy the waste of the pets I breed.”

A brief dissertation on Mike’s (paid) work examining semen, leads us into the world of a foetus, closely followed by a discussion on termination, consciousness and death – all in the space of seven pages. It’s a roller coaster, but the exploration is serious.

Some of the chapters are particularly thought provoking. “Addicted” examines some of the evidence for becoming addicted and the ensuing behaviours:

“I grew up with an alcoholic father. All too often I had it explained to me that alcohol addiction was a disease, usually in justification of a relapse or a particularly severe bender……Somewhere in there was a man who I believed could choose to drink or not to drink. To abuse or not to abuse. To control his rage, to show affection to his family. Yet to him, a force beyond his control was guiding his hand, unleashing a monster he could disown with the phrase ‘it’s a disease’”.

This is a familiar theme and one which deserves lengthy debate.  How should society deal with someone who commits a crime, but acts with some degree of madness? Mike summarises the case of Anders Breivik, the Norwegian terrorist who murdered 77 people, and who was pronounced sane at his trial, despite contradictory psychiatric assessments, including one of paranoid schizophrenia:

“… our ability to distinguish between who is sick and who is sinful is at best flimsy, and at worst based on our social biases than on anything medical, There is no pigment, no chemical, no gene, no physical kink or fracture that can delineate the insane from the free-thinking.”

Though denying that he is a scientist, Mike McRae once worked in a medical laboratory and has completed tertiary studies in health and medicine. He has been “writing about science in various forms for over a decade, producing educational materials, news items, and museum displays for a broad range of organisations.” He currently writes and edits ScienceAlert. Unwell is his second book after the 2011 publication of Tribal Science: Brains, Beliefs & Bad Ideas.

His purpose is noble:

We face the challenges of deciding which biological traits are good and which are bad, who should decide the difference and who can access the resources to make a difference. To meet these challenges, we first need to know what we mean by disease, and distinguish it from its moral underpinnings.”

This is a book which demands our concentration, but its style, mercifully, is more entertainment than encyclopaedic. If it teaches us anything, it is that fashion and history are never predictable. Perhaps during the tenure of the current US president, Americanitis will make a return, or perhaps the incumbent will lend his name to a new disease.



By Mike McRae

University of Queensland Press (UQP)

ISBN: 9780702260315


$29.99 (paperback)


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